this is a blog for patients and their families to read and enjoy. It's a series of stories about patients. I'm trying to educate the layman about medicine so that they can empower themselves to acquire the best medical care available to them.

Thursday, September 19, 2013

Recently, while working in a rural agricultural town in
Colorado, I walked into see a patient, who had been coming to this particular
family practice for 20 years. She had initially been diagnosed with
multiple sclerosis 25 years ago, when she and her husband had been living in
Denver. For the first few years she had been seen at the multiple
sclerosis center, based out of one of the community hospitals in Denver.
It had a large referral base from six surrounding states.
Georgia told me that she was very happy with the care she received there from a
physician who was very compassionate and willing to work with her. When
he retired, she saw his colleague, but didn’t get along with him, so she quit
going, and hence hadn’t received care for her MS since.
Then her husband, a dentist, decided to accept a position in this rural,
agricultural town that I was working in. During this time, Georgia had
learned to handle her multiple sclerosis relapses through mental determination,
rest, tylenol/motrin and lots of physical therapy. She knew that it would
eventually go away, it always had in the past. But with each episode
(thankfully they only came along every few years) she was left with a little
more pain and disability to chronically live with.

Then there was the day that I saw her in clinic. Georgia was complaining
of non-stop diarrhea, low back pain which almost had her immobilized. She
also had generalized abdominal pain with referred pain down both legs. To
say it mildly, she was miserable.
I ended up working up her diarrhea/abdominal pain and got a MRI of her
back. Her diarrhea was caused by her MS (no surprise there), as was her
lower back pain/abdominal pain which the MRI revealed was due to partial
myelitis (another sign of active MS). I gave Georgia some lomotil to
control her diarrhea, and Cymbalta to help control her pain. But that
still left her with her MS, in its acute flare-up.

Diagnosing MS:

Done by doing a MRI of the brain which needs to show white matter disease
(the brain, typically black on the MRI shows white spots within it)

Over the course of working her up, I ended up seeing her three times in a two
weeks. Each time I saw Georgia I continued to try to counsel her that she
needed to return to Denver to be seen by a MS specialist. Georgia’s
memories of the last MS specialist she had seen were still so strong that she
would barely even discuss this with me. I kept trying. I gave her
loads of updated information on MS, the newer treatment modalities available
and what she could expect from them. She brought them home for both her
husband and her to read. She later told me that her husband had devoured
the information, and had even looked some additional information up on the
internet.

It wasn’t until I kept reiterrating (over the three
clinic appointments) my having previously worked alongside Dr. James
(pseudonym), a MS specialist who saw patients at the medical school in Denver,
how compassionate he was, how willing he was to work with patients, how caring,
kind and friendly he was with all of his MS patients, that she finally relented
and gave me permission to make her an appointment with him.

Clinical Course of MS:

MS can take one of three pattersn: relapsing-remitting (my patient),
secondary prgoressive or primary progressive.

I quickly called and made the referral. I asked the
receptionist to make it an urgent appointment due to the patient’s
symptoms. Thankfully, there was a cancellation and my patient was able to
take this appointment, two weeks away. She would have to be in a car for
two hours driving back to Denver to see him, but I knew it would be worth
it. The next day she called in to leave me a message. Her husband
was so estactic that she had finally decided to pursue treatment again for her
MS, that he had taken the day off from his dental practice and was going to take
her up to Denver himself.
Fortunately I was still working at this clinic when she showed up six weeks
later. She hobbled in, using a cane, but had the biggest grin on her face
you would ever see. She told the clinic secretary that she had to talk to
me.
I was just coming out of one of the exam rooms when I saw her at the front
desk. I motioned for her to come on back into one of the empty exam
rooms, which she did.
“So, tell me I want to know what Dr. James said.”
With tears running down her cheeks, “Sharon, you were so right. He is the
kindest, most compassionate physician I have ever met. My husband just
thought the world of him. He’s started me on a oral medication,
Fingolimod which is working wonders for me. I saw him two weeks ago for
follow-up and I’m supposed to go back in two more weeks for another
follow-up. The medicine is working so well for me that I’m back doing
physical therapy and am able to walk short distances again. I can’t thank
you enough.”
“Oh, I’m so glad you went, because he was exactly what you needed! I’m
happy that you finally found someone you can work with.”
“So am I, so am I!”

About Me

I'm a physician assistant with more 20+ years (and counting) of clinical medicine experience. I'm writing this blog for you, a potential patient, or for one of your family members, in order to empower you to acquire the best medical care available.
Please do not look upon these stories as direct medical advice. If you have any questions or think you need to change your medical treatment, please discuss this with your own physician.